USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 35
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(Signed)
Dominic Thomas Staffier
M. D.
21 Breed St.
(Address)
E. Boston
Dat
Sept 2719
62
a Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
Oct 1, 19 6 2
19
7 NAME OF
FUNERAL DIRECTORichard C. Kirby, Inc.
ADDRESS
917 Bennington St. E. Boston A TRUE COPY
Received and filed
OCT 5- 1982
19.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
(write the word)
widowed
HUSBAND of
Josephine V. Hayes
(or) WIFE of.
(Husband's name in full)
12
AGE
86.
Fears
1
Months
26
Day
If under 24 hours
Hours ...
.Minutes
13 Usual
Occupation :
Attorney .... retired
(Kind of work done during most working life)
14 Industry
or Business :
Legal
15 Social Security No.
16 BIRTHPLACE (City)
Boston
(State or country)
Mass.
17 NAME OF
FATHER
Jarius S. H endrick
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Vermont
19 MAIDEN NAME
OF MOTHER
Jane O' Brien
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Informant
Helen McGinn, Niece
(Address)
52 Gladstone St., E. Boston
ATTEST:
Hugh Ferons
DATE FILED
(Registrar of City or Town where death occurred)
Sept 27, 1962
19
ORM R-302
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town
MARGIN RESERVED FOR BANDING
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
SOM - 10.61.931673
(Registrar of City or Town where deceased resided)
11 If married, widowed. or divorged
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral Hemorrhage
(a)
Aug
20
62
I last saw h ...... alive on
im
Walter J.H endrick
(Was deceased a
U. S. War Veteran,
PARENTS
DATE OF BURIAL
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE .. DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
1
OCT - 51962 AM
MR-305 1
PLACE OF DEATH
Essex
(County)
Danvers
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Denvers
(City or town making return)
Registered No.
1.24
§(If death occurred in a hospital or institution,
No. Denvers State Hospital, H. thorne St. ( give its NAME instead of street and number)
Joseph G. Crafts
[(Was deceased a
{U. S. War Veteran,
(If deceased is a married, widowed or divorced woman, give also maiden name.)
[if so specify WAR)
56 Court Road
.......
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.years.
8
months.
5
In place of residence .. ... years ....
... months ......
days.
MEDICAL CERTIFICATE OF DEATH
WRITE PLAINEI, WITTT UMLAVING DIALS INA VA the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided Injury (How did injury occur ?)
Sept. 28. 1962
(Year)
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Atelectasia of lune pulmonary emphysema on D. L. less 24 hrs
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
male
10 COLOR
white
11 CITIZEN
OF U.S.
YES
NO
12 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
12a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 DATE OF BIRTH
Sept. 7. 1205
14
AGE67 Years.
0
Months.
21 Days
If under 24 hours
Hours
Minutes
15 Usual
Occupation :
Bank Guard
(Kind of work done during most of working life)
16 Industry
or Business:
17 Social Security No.
...
012-16-7333
18 BIRTHPLACE (City)
(State or country)
Mass.
19 NAME OF
FATHER
George Crafts
20 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
21 MAIDEN NAME
OF MOTHER
Ann Lahey
22 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
23
Mary E. Sheehan
8 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby.
Inc
ADDRESS
Boston, Mass.
Received and filed OCT 8 - 1962 19
(Registrar of City or Town where deceased resided)
PARENTS
M. D.
Date 9 - 28 ~ 1962
Bque Hills Cemetery, Mattapan 7 Place of Burial or Cremation. Oct. 1.
(City or Town) 19.62
Informant
(Address)
"Hathorne, Mass,
A TRUE COPY.
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
.......
10/1/
19 62
.....
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
3 DATE OF
DEATH
(Month)
(Day)
5 Accident, suicide, or homicide (specify)
Manner of
(Specify type of place)
Nature of
Injury
(Signed)
......
Rolph E. Foss
Ralph D.
(Address)
Habedr. NOSS
DATE OF BURIAL
25M-3-61-930213
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at
Where did
Injury occur ?
(City or town and State)
as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
Date and hour of injury
19.
If accidental, was injury causally related to the death ?
Did injury occur in or about home, on farm, in industrial place, or in public place ?
......
Boston
While at work?
.Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased ? If so, specify
St.
Winthrop,
Mass ..
SERT.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
001 - 8138211
SERVICE NUMBER
R-301 1
STICTIONS OR MCERTIFICATE
In iving & IF DEATH t enter re han one I.for each ).b) and (c)
e's not mean @, of dying, s eart failure, 1. tc. It means es', or compli- which caused
it'ss, if any, i've rise to ause (a). the under- ause last.
mions contrib- o cath but not Ithe terminal codition given
t- Chapter 137, 1954 requires ians to print or Ne Fause e of death hertificates, and ot 18. Acht of squires Physl- print or type ender signsture.
1-62
PLACE OF DEATH
SUFFOLK
(County>
BOSTON (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH CHIMAD DIVISION OF VITAL STATISTICS STANDARD
175
OUT - OF - TOWN
To be filed for burial perm.it .with Board of Health or its Agent.
Registered No.
f(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME MARY ( First Name )
CUCINOTTA
[(Was deceased a
U. S. War Veteran.
(if so specify WAR) NO
( If deceased is a married. widowed or divorced woman, give also maiden name.)
39; travers
WINTHROP
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years ..
... months.
40 days.
.
In place of residence.
.years
months ............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
W
10 CITIZEN
OF U.S.
YES
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
lla If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
FRANCESCO CUCINOTTA
(Husband's name in full)
12 DATE OF BIRTH
13
AGE.
75 Years
.Months ..
.Days
If under 24 hours
Hours.
.. Minutes
14 Usual
Occupation :
...
AT HOME
15 Industry
or Business :
16 Social Security No. .
NONE
17 BIRTHPLACE (City)
(State or country)
ITALY
18 NAME OF
FATHER
Francesco auditore
19 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
20 MAIDEN NAME
OF MOTHER
Rosaria Barbera
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
ITALY
22
Informant<
(Address)
14 marion St Cast Boston
I HEREBY 'CERTIFY tham a satisfactory standard certificate of death was filed with The BEFORE the burial or transit permit was issued :
.....
Sinature of gent of Board of Healthy or other
Received And filed Charles H. Machu 19
PARENTS
HOLY CROSS CEMETERY
MALDEN
6 Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
REFRENA AUG. 25
1962
7 NAME OF
FUNERAL
DIRECTOR
PENNACCHIO + SON
ADDRESS 59 So. MARGIN ET. BOSTON
AUG 2 0 1962
Ave
(a) Residence. No.
( L'sual place of abode)
3 DATE OF
DEATH
Hügust
22
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
Jiely 12
19 62 to Krusjest
That I attended deceased from
22
19 6.2
I last saw h.s.r ... alive on
payant 22, 1962 d
.... , death is said to
have occurred on the date stated above, at 6.30 pm.
INTERVAL
BETWEEN
ONSET ANO
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
SHOCK.
Due To
INTERNAL HEMORRHACE
(b)
Due To
Acute faftra ciliar
(c)
OTHER
PEMPHIGUS VULGARIS
SIGNIFICANT
CONDITIONS
PENNTiques Vulgaris
Was autopsy performed?
yes
Wbat test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Willy N. Paulas
M. D.
WILLY A DICHAS
(Address)
Hommel Hattak Hry Date Leup. 22, 62
(Print or Type, Name)
No.
L'emuel Statute starfatal
CERTIFICATE OF DEATH
(Middle Name)
( Last Name)
Sally Mac Dougall
$12632 8/24/62
(Kind of work done during most of working life)
A TRUE COPY ATTEST: Charles it Mackie City Registrar
OCT 311962 AM
CIM R-301
der burial permit od of Health Agent. TICTIONS
L ERTIFICATE
TR TYPE ( CAUSES EATH ": enter elan one se or each ››) and (c)
ds not mean d of dying, cart failure, c. It means a, or compli- sich caused A
this, if any, ve rise to muse (a), the under- Iuse last.
uions contrib- o cath but not I the terminal cidition given
5 7 37 Kフノ
31-62
1-932382
PLACE OF DEATH
Suffolk County) Boston 20 (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT - (0 176
(City or Town making this return) 084458
STANDARD CERTIFICATE OF DEATH Registered No. New England Baptet Hospital (If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT
YES
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
85 Quire : [PC
(a) Residence. No
80 Cliff Avenue
Winthrop.
St
(Usual place of abode)
Length of stay: In place of death ...... years month 6
.. days. In place of residence .......... years ...
(If nonresident, give city or town and State)
3 months days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
August
27
1962
(Month)
(Day)
(Year)
IHEREBY CERTIFY
August 1, 162
to ...
August
27
I last saw hl Mive on
August
26 1962 death is said to
have occurred on the date stated above, at
3.50 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
HEPATIC FAILURE
Due To
CARCINOMA OF PANCREAS
(b)
Due To
WITH METÁSTASES
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
Laparotomy
What test confirmed diagnosis ?
5 Was disease or injust- in any
If so, specify
ay related to occupation of deceased ? le
(Signature)
M. D.
SOWHEY
PARK
(Print or Type Name)
(Address)
605 COMM. AVE.
.. Date ....
8.27
1962
WINTHROP WINTHROP 6
(City or Town)
Place of Burial or Cremation
AUG 30
1962
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
MAURICE W. KIRBY
21OUTWITHROP ST. WINTHROP
Received and filed
ADDRESS
AUG 30 19627
.
.. 19
Charles 31 Macks
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
PINO
(Give maiden name of wife in full)
(or) WIFE of
1
(Husband's name in full)
12
AGE 5L
'ears
Months ...
Days
If under 24 hours
Hours .......
.Minutes
13 Usual
Occupation :
ROOFER
(Kind of work done during most working life)
14 Industry
or Business:
ROOFING
15 Social Security No ...
029103281
16 BIRTHPLACE (City)
(State or country )
NEW YORK
17 NAME OF
FATHER
DUMENTO CASAMENTO
PARENTS
18 BIRTHPLACE OF
FATHER (Cily)
(State or country)
ITALY
19 MAIDEN NAME
OF MOTHER
MARIA SABOTO
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
ITALY
21 Informant
FABIA CASAMENTO
(Address)
80 CUFF AVE. MINTARE
I HEREBY CERTIFY that a satisfactory standard certificate of death was fico with me BEFORE the burial or Transit permit was issued: D. T. Le Llamala
(Signature of Agent of Board of Health or other)
B72714
8/29/62
(Date of Issue of Permit)
ALT. .. Hewill
-
(write the word)
manuel
That I attended deceased
from
19
62
INTERVAL BETWEEN ONSET AND DEATH Que
month
11 If married, widowed, or divorced.
HUSBAND of
1922 FLAVIA
(Was deceased a
U. S. War Veteran,
if so specify WARI.
mass
WWII
VOTI. ?
M. Angelo A. Casamento
(Registrar) | (Concial Designation)
I
.
A TRUE COPY ATTEST:
narkes it Mackie City Registrar
-
0
OCT 311962 AM
R R-301A I
(County)
BOSTON
(City or Town)
Massachusetts General Hospital
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH PHILLIPS HOUSE
177
OUT - CF. - TOWN
To be filed for burial permit with Board of Health or its Agent. 08916
Registered No.
S(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) PHYSICIAN - IMPORTANT
Mr. Harold B Stewart
2 FULL NAME
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
#48 Beacon St., Winthrop, Mass.
St.
(L'sual place of abode)
9
61
(If nonresident, give city or town and State)
Length of stay: In place of death.
........
years
months
.days.
In place of residence
.years ..
.. months ............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
September 13th, 1962
8 SEX
Male
9 COLOR
white
10 SINGLE
(write the word)
DEATH
(Month)
(Day)
(Year)
19
4 I HEREBY
Sept . 5
62
CERTIFY.
That we attended deceased from
19
last saw h.
imalive on
Sept. 13.
19
death is said to
62
have occurred on the date stated above, at
12: 152.m.
INTERVAL
BETWEEN
ONSET AND
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Tension Pneumothorax
DEATH
15 da
82
69
5
.. Months.
7
.Days
If under 24 hours
.Hours .............. Minutes
Due To
Chrondc Bronchitis and
8 yrs
13 Usual
Occupation :
Retired CARPENters Supervisor
(Kind of work done during most of working life)
14 Industry
or Business
Chelsea NAVAL Hospital
15 Social Security No. ...
029-07-5078
MONTAQUE
P.EJ.
Was autopsy performed?
no
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
M. D
(PRINT OR TYPE SIGNATURE)
19
WINTHROP COM, WINTHROP Mas. 6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Sept. 15 . 19 62 19
7 NAME OF
FUNERAL DIRECTOR
William T. MCDONALD
ADDRESS' 19 Yale Ave, Wakefield
Received and hled SEP 14 1962 19
carles of macke
PARENTS
17 NAME OF
FATHER
BENJAMIN F. STEWART
18 BIRTHPLACE OF
FATHER (City)
Brudnell, P.E.T.
(State or country)
CANADA
19 MAIDEN NAME
OF MOTHER
Lilly D. Johnstone
20 BIRTHPLACE OF
MOTHER (City)
MENTAQue, P.E.Z.
(State or country)
CANADA
MRS. DOROTHY P. Stewart
21
Informant
(Address)
48 Beacon ST. Winthrop Max
I HEREBY CERTIFY that a satisfactory standard certificate of death Is filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
12.884
9-13-62
(Official Designation)
(Date of Issue of Permit)
NS UCTIONS FOR CA CERTIFICATE
I giving SEOF DEATH o ot enter or than one ul for each )(b) and (c)
pes mat mean mul: of dying, as heart failure, ig etc. It means sae, or campli- phich caused
dions, if any, chave rise ta re rause (a). inthe under- Ricause last.
on tions contrib- taleath but not the terminal ndition given 1
se of death Jon hertifcare and Ach lot PI- , quret Physi- s) print or type e ider signature.
-
el Director susse only AK, Ink. 1962
PLACE OF DEATH
SUFFOLK
(b)
Emphysema
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
11 IF STILLBORN, enter that fact here.
(a)
AGE
Years ..
10a If married, widowed, or divorced
DOROTHY R. Keegan
HUSBAND of
(Give maiden name of wife in full)
MARRIED
WIDOWED
or DIVORCED Married
to.
Sept. 13,
(Was deceased a U. S. War Veteran, (if so specify WAR)
WW. I
No.
3 ot . Charler 17. (Signed) 1954. requires Charles.L ... Clay ... M. D. sians to print or he cause or (Address) Ama's. Dits Must Goall. Home. Date.
16 BIRTHPLACE (City)
(State or country)
CANADA
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
6
NOV :51962 AM
X PLACE OF DEATH
Suffolk (County)
PENSE
Winthrop
(City or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 178
Winthrop Community Hospital No.
f(If death occurred in a hospital or institution,
St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
Edna (MacMullen) Lorance
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
180 Winthrop St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .
......... years ....... .. months
3.
days. In place of residence
40
years.
months ..
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
3 DATE OF
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
-
20
19 Gt to Oct. 2
19/2 2
I last saw h. ...... alive on
0.2.
19.6.2. death is said to
have occurred on the date stated above, at
of: 5-3 m.
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
10min
65
2
Months.
21
Days
If under 24 hours
Hours ........
.. Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
013-20-1397
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Boston
17 NAME OF
FATHER
Edwin Mackullen
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass
Boston
19 MAIDEN NAME
OF MOTHER
Unable to obtain
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
Portland
21 Joseph F Lorance
Informant
(Address)
100 winthrop St. winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph 6. Sirianni (Signature of Agent of Board of Health or other) (HB)
Realty Officer
Det, 3,1962
(Official Designation) (Date of Issue of Permit)
%
TECTIONS IR & ERTIFICATE
n ving OF DEATH n enter e lan one se or each ) and (c)
dis not mean d of dying, art failure, c. It means us or compli- ich caused
tis, if any, ve rise to huse (a), ghe under- use last.
d ons contrib- ath but not tothe terminal codition given
- hapter 137, 54. requires a: to print or h
cause or death on e ficates, and r 8, Acts of evires Physi- o rint or type n r signature.
6 Puritan Lawn winthry Peabody, Mass
Place of Burial or Cremation
DATE OF BURIAL
(City of Town) Oct. 4 ,62
19
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop, Lass
Received and filed
OCT 3 - 1952
19
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ? If so, specify ).
(Signed) COUSKAD GREGORIE
{PRINT OR TYPE SIGNATURE)
199 Washi will ard 10/2
1962
(Address)
Due To Verlosclerosis
(b) Generalized V
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Joseph F Lorance
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Cerebro Vascular
hemorrhage
1962
(a) Residence. No. (Usual place of abode)
f(Was deceased a U. S. War Veteran, [if so specify WAR)
MARRIED)
WIDOWED Married
or DIVORCED
12
AGE
Years.
At home
1 59-925686
MR-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians will certify to such deaths only as those of, persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only a's those of persons who, though disabled by recognized disease unrelated to any form of . injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
OCT 3. 1962 PM
Statement of Occupation .- Precise statement of occupation is very imple tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
PLACE OF DEATH
I Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return)
Registered No.
179
[(If death occurred in a hospital or institution, No. St. ( give its NAME instead of street and number) Winthrop Community Hospital M.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
33 Neptune Rd. E. Boston Mass. East Boston
(Usual place of abode)
Length of stay: In place of death .......... years .......... months 1 .days. In place of residence. ... months .......... days.
1.8 ears.
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
WIDOWED
DIVORCED
UNKNOWN
Married
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
James H. Petipas
(or) WIFE of
(Husband's name in full)
12
AGE.5.8 Years.
9 Months ... 26. Days
If under 24 hours
Hours ......
Minutes
13 Usual
Housewife
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
At home
15 Social Security No ..
023-16-9884
16 BIRTHPLACE (City).Cape Breton
(State or country )
Nova Scotia
17 NAME OF
FATHER
Daniel Fougere
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Cape Breton
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Philomena Bennett
20 BIRTHPLACE OF
MOTHER (City)
Cape Breton
(State or country)
Nova Scotia
21 Informant
Mr. James H. Petipas-hus.
33 Neptune Road,
East Boston, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
Galite
10/3/62
(Date of Issue of Permit)
(Registrar)|| (Official Designation)
2-932382
FIRM R-301
der burial permit Bed of Health Agent. TI CTIONS OR CERTIFICATE
TOR TYPE ₹ CAUSES EATH
It enter ehan one sefor each ,3) and (c)
a's not mean Rt of dying, Heart failure, , tc. It means 0, or compli- hich caused
tiss, if any, ve rise to Cause (a), gthe under- ause last.
uions contrib- o cath but not t the terminal adition given
(Signature)
In. Traunstein
M. D.
M.TRAUNSTEIN JR, M.D.
(Address)
23 BARTLETT.
(Print or Type Name)
Date 10/2
1962
Holy Cross Cemetery Malden
6
Place of Turial or Cremation
(City or Town)
DATE OF BURIAL
October 5th
1962
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby, Inc
ADDRESS17 Bennington St. E.Boston
Received and filed
001-3 --- 1982
19.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Oct.
2
1967
(Month)
(Day)
(Year)
4 LHEREBY CERTIFY,
That I attended deceased from
SEPT. 24, 1962
to ..
Oct.
2
19
62
I last saw h.Adalive on
Oct.
2
19662, death is said to
have occurred on the date stated above, at
7:30 A
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CEREBRAL
HEMMORRHAGE
INTERVAL BETWEEN ONSET ANO DEATH 24 HRS
2 VES
Due To
GENERALIZED ARTERIO -
(c)
SCLEROSI'
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
No
What test confirmed diagnosis? Clinical + LAB.
5 Was disease or injury in any way related to occupation of deceased? YO If so, specify
ARTERIOSCLERCtic + HYPER-
(b)
INSIVE HEART DIS,
3 YRS
8 SEX
Female
(a) Residence. No.
(If nonresident, give city or town and State)
2 FULL NAME .. Eva. Petitpas ( Fougere )
(If deceased is a married, widowed or divorced woman, give also maiden name.)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE. RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
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